| NPI | 1104952076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 50959-020) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: WI 50959) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2021-11-07 |